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General NPI Number Information
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NPI Number | 1851878045
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Entity Type | Individual
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Provider Name | MARIA JESUS TAGLE-CASTRO PARSA DDS
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Gender | Female
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 5800 VAN BUREN BLVD STE 110
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City | RIVERSIDE
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State | CA
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Zip | 92503-9031
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Country | US
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Telephone | 951-688-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 25471 CADILLAC DR
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102839
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License Number State | CA
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